APPLICATION FOR MEMBERSHIP

                                                   Please Print  & Return 

Secretary
Parramatta & District Historical Society Inc.
P.O. Box 1384
PARRAMATTA NSW 2124
email: parramattahist@tpg.com.au

Dear Secretary

I wish to join the Parramatta & District Historical Society Inc.

I understand full membership commences after payment of joining fee and annual subscription and acceptance by the members. 

INDIVIDUAL MEMBER: Joining Fee $10, Annual Subscription $30 – total $40.00

FAMILY MEMBER:   Joining Fee $10, Annual Subscription $40 – total $50.00

FULL NAME : (Dr/Mr/Mrs/Miss/Ms)..........…………............................................................................

ADDRESS :….......................................................................................................................

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TELEPHONE : (Home)...............................................................

                        (Bus.)………………………………………………

                        (Mobile)……………………………………………

E-MAIL :.......................................................................................................................

If STUDENT:               Student No.                        School/Uni./College                                                                               

INTERESTS :…………………………………………………………………………….................................................…

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DATE : ......................................................................................

SIGNATURE : ..........................................................................

Send your application by email or post to the Society at the address shown at the top left of the form. 
Please also pay the Joining Fee and Annual Subscription by either:
(a) Direct Transfer to the Society's account at CBA Parramatta, BSB 062-223, Account 00900240, including MEMB and your name in the reference
(b) By cheque or mail order, payable to "Parramatta & District Historical Society"

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Office Use only :

Acceptance:

Receipt No. .................

Newsletter: ……………………………………..

Confirmation letter:……………………………

Membership No………………………………
 

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